Basic Information
| Provider Information | |||||||||
| NPI: | 1265480891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATANASOSKI MCCORMACK | ||||||||
| FirstName: | VIOLETA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ATANASOSKI | ||||||||
| OtherFirstName: | VIOLETA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1700 NW 49TH ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547607171 | ||||||||
| FaxNumber: | 9547641722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 SE 3RD AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333162521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547607171 | ||||||||
| FaxNumber: | 9547641722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME54176 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | ME54176 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | ME54176 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | P00198045 | 01 | FL | RR MEDICARE | OTHER | 061104200 | 05 | FL | MEDICAID | 08782 | 01 | FL | BCBS | OTHER |